Utah gets OK from feds to run own health insurance exchange

SALT LAKE CITY — Utah is one of four GOP-led states given the go-ahead Thursday by the federal government to run its own health insurance exchange under the Affordable Care Act.

Yet to be determined, however, is whether Utah officials are going to be willing to tailor a state-run marketplace for residents to purchase health insurance to meet the requirements of President Barack Obama's health reform plan.

Gov. Gary Herbert has already said that the mandated individual coverage would be made available in addition to Utah's Avenue H health insurance exchange for small business, but he has balked at the state getting involved with other provisions of the act.

“Utah’s position on our state health exchange has not changed and it will not change. Because it’s consumer-driven, market-based and flexible, Utah’s model is the right solution for Utah," Herbert's deputy chief of staff, Ally Isom, said.

Isom said the governor will review the approval granted and "determine if the conditions are acceptable or reasonable for our state exchange — and that includes sitting down with legislators — but there is nothing about Utah’s path that changes as a result of today’s announcement.”

A spokesman for the Department of Health and Human Services, Gary Cohen, said the approval was granted on the condition that officials comply with all federal regulations.

"There are a number of steps Utah needs to take to expand individual marketplace and otherwise comply with provisions," Cohen said in a conference calls with reporters, including developing a navigation component that helps people find information and get enrolled.

The Obama administration granted conditional approval Thursday to Utah, Idaho, Nevada and New Mexico, all led by GOP governors, to build and run their own health insurance markets for consumers.

A total of 17 states and Washington, D.C., have received the approval. The federal government will put together and operate exchanges in states that opt out of participating.

Herbert wrote Health and Human Services Secretary Kathleen Sebelius in December that he was confident that Utah's health exchange already "meets the broad goals and objectives" of the federal act despite its differences.

The governor cited instances where he believes the federal government, rather than a state-run exchange, should step in, such as determining whether someone is eligible to use tax credits toward the purchase of private insurance.

However, Niederhauser acknowledged there are still many details that need to be worked out with the federal government. At least initially, he said, there should be no need for new state appropriations.

Niederhauser said the federal government needs to give the state some leeway. "If they give us no flexibility, what's the point? Let them run it," he said. "If they're serious about allowing us the flexibility, we're serious in running a state exchange."

House Speaker Becky Lockhart, R-Provo, was less optimistic that an agreement could be reached.

"I would rather have the federal government run the exchange," the speaker said. "It's not a partnership. They demonstrated amply through the years that a partnership with the federal government usually means they tell us what to do and we pay for it."

Lockhart and retiring Senate President Michael Waddoups, R-Taylorsville, sent a letter to the governor in November stating that legislative leaders "decided unanimously that Utah should not spend any state time or money to build and run a federal exchange program."

She said it's "a big step to go from providing health coverage to 7,000 small-business employees to offering affordable health coverage to Utah's 400,000 uninsured residents in less than a year."

And while Utah has been a pioneer in state-run health care reform with Avenue H, Hilman said the exchange still falls short of new requirements for consumer assistance, transparent government and some health benefits.

Hilman and Jason Stevenson, the policy project's education and communications director, said they will work with other groups to keep the pressure on state leaders to include those protections.

"Just because Utah has requested significant flexibility to design a state-run exchange doesn't mean that Utah's residents should be denied the protections mandated by the Affordable Care Act and offered by other states," Stevenson said.